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NURS 305 > Chapter 44: Pain and Pain Management > Flashcards

Chapter 44: Pain and Pain Management Flashcards

1
Q

What are the challenges of pain management?

A
  • nurse cannot see or feel patient’s pain

- purely subjective; no two can experience the same pain

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2
Q

Pain is defined by the International Association of the Study of Pain as

A

an unpleasant, common subjective sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

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3
Q

Pain

A

is whatever the experiencing person says it is, existing whenever he/she says it.

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4
Q

Physiology of Pain

A
  1. transduction
  2. transmission
  3. perception
  4. modulation
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5
Q

transduction

A
  • converts energy produced by thermal chemical or mechanical stimuli into electrical energy.
  • the pain producing stimulus starts at the periphery and travel across sensory periphery nerve fibers (nocireceptors) causing action potential leading to transmission.
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6
Q

transmission

A
  • cellular damage caused by stimuli resulting in release of excitatory neurotransmitters.
  • the transmitters surround the pain fibers and spread the pain message to cause inflammatory response
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7
Q

perception

A

painful stimuli then travels through transmission to the cerebral cortex to be processed in the brain and the person becomes aware of the pain.

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8
Q

modulation

A
  • once the brain perceives the pain, release of inhibitory neurotransmitters help to produce analgesic effect.
  • last phase of pain impulse
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9
Q

Gate-Control Theory of Pain

A
  • gating mechanisms located along the CNS regulate or block pain impulses.
  • pain impulses pass through when the gate is open and are blocked when the gate is closed.
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10
Q

closing the gate is the basis for

A

non-pharmacological pain relief: pain threshold (the point at which person feels pain)

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11
Q

Responses to Pain

A
  1. physiological responses

2. behavioral responses

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12
Q

physiological responses

A

when pain causes fight-or-flight response resulting in stimulation of sympathetic and parasympathetic nervous system

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13
Q

behavioral responses

A

influenced by person’s culture, experiences, and perceptions of pain

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14
Q

Acute pain

A

warns people of injury and disease; protective

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15
Q

Characteristics of acute pain

A
  • identifiable cause
  • short in duration
  • limited tissue damage
  • self-limiting
  • lasts less than 6 months
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16
Q

Chronic pain

A
  • non protective and serves no purpose.

- episodic pain, cancer pain, idiopathic pain

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17
Q

Characteristics of chronic pain

A
  • prolonged pain
  • varies in intensity
  • lasts longer than 6 months
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18
Q

Common Misconceptions about Pain

A

the following statements are false:

  • Patients who cannot speak do not feel pain
  • Patients who abuse substances overreact to pain
  • Patients with minor health conditions feel less pain compared to those with severe physical alternation
  • Chronic pain is psychological
  • Patients who are in a hospital experience pain
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19
Q

Factors Influencing Pain: Physiological Factors

A
  • Age
  • Fatigue
  • Genes
  • Neurological Function
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20
Q

Factors Influencing Pain: Social Factors

A
  • Attention
  • Previous Experience
  • Family and Social Support
  • Spiritual Factors
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21
Q

Factors Influencing Pain: Psychological Factors

A

Anxiety and Coping Style

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22
Q

Factors Influencing Pain: Cultural Factors

A

how patients cope with pain based on what is expected and accepted by their culture

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23
Q

Assessment of Pain

A
  • Determine the patient’s perspective of pain
  • Obtain the pts description of pain
  • Utilize pain scales that are valid and reliable
  • Review Potential factors affecting pts pain
  • Identify medical comorbidities
  • Pts own perspective of pain
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24
Q

Determine the patient’s perspective of pain

A

include hx of pain, what it means, how it affects the pt emotionally, physically and socially

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25
Q

Obtain the patient’s description of pain

A

characteristics of pain

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26
Q

Utilize pain scales that are valid and reliable

A

make them specific to patient population

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27
Q

Identify medical comorbidities

A

diabetes, cancer, hypertension, thyroid issues…

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28
Q

Patient’s Own Perspective of Pain

A
  • be sensitive to patients level of pain: determine what level will allow the pt to function.
  • if pain is acute and severe, it is unlikely that a pt is able to describe their pain in detail: assess for location, severity and quality; wait for the moment when the pt feels better for more detailed pain assessment (PQRST)
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29
Q

PQRST

A
  • Palliative or Provocative Factors
  • Quality
  • Region (location)
  • Severity
  • Timing

-Effect

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30
Q

Timing

A

Onset, Duration and Pattern

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31
Q

Location of Pain

A
  • superficial or cutaneous
  • deep or visceral
  • referred
  • radiating
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32
Q

Severity

A

use appropriate pain scale: numerical rating scale (rates pain from 0-10); verbal descriptor scale (six word descriptors from no pain to unbearable pain), faces pain scale (cartoon faces ranging from 0-6)

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33
Q

Quality

A

tell me what the discomfort feels like

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34
Q

Aggravating and Precipitating Factors

A

describe what activities make the pain worse

35
Q

Relief Measures

A

describe what activities make it better

36
Q

Effects of Pain on the Patient

A
  • behavioral effects
  • influence on ADLs
  • concomitant symptoms
37
Q

behavioral effects

A

assess for vocal response, facial and body movements, and social interaction

38
Q

influence on ADLs

A

assess for the ability to participate in routine activities

39
Q

concomitant symptoms

A

assess for coexisting symptoms adding to pts pain

40
Q

Nursing Diagnosis for Pain

A
  • accurate only after a complete pain assessment
  • results of complete data and collection analysis
  • reveals presence of existing or potential pain
41
Q

Examples of Nursing Diagnosis RT Pain

A
  • Activity Intolerance
  • Impaired Physical Mobility
  • Impaired Social Interaction
  • Dressing Self-Care Deficit
  • Ineffective Coping
  • Anxiety
42
Q

Pain Management Planning

A
  • Determine goals and outcomes
  • Choose interventions for pain relief
  • Prioritize interventions according to patient’s level of pain
  • Educate the patient and family on pain and pain management when appropriate
  • Collaborate with other health care team members
43
Q

Implementation

A

requires an individualized approach

  • try the least invasive or safest therapy first along with what worked for the patient previously.
  • use strategies to minimize patient pain through caring behaviors
44
Q

Implementation and Health promotion

A
  • maintaining wellness

- non-pharmacological pain relief interventions

45
Q

maintaining wellness

A

have the patients actively participate in their own wellbeing

46
Q

Non-pharmacological pain relief interventions

A

can be used alone or w/ pharmacological interventions (cognitive-behavioral pain interventions, physical pain relief interventions)

47
Q

Non-pharmacological pain interventions are useful for patients who

A
  • cannot tolerate pain medications
  • wish to reduce multiple medication administration
  • seek alternative methods
48
Q

Pharmacological interventions have a higher priority in ______ compared to non-pharmacological.

A

acute pain

49
Q

Examples of non-pharmacological pain interventions

A
  • guided imaginary
  • relaxation
  • distraction
  • music
  • cutaneous stimulation
  • herbals
  • reducing pain perception and reception
50
Q

guided imagery

A

reduces the pts affective and cognitive pain perception

51
Q

relaxation

A

allows the pts mental and physical freedom and develop sense of control

52
Q

distraction

A

strategies that allow the pt to ignore or become less aware of pain

53
Q

music

A

useful in treating acute or chronic pain, stress, anxiety and depression

54
Q

cutaneous stimulation

A

stimulation of the skin through massage, warm bath, cold application, or transcutaneous electrical nerve stimulation (TENS)

55
Q

herbals

A
  • Important to ask the patient about ALL substances they take to relieve pain
  • Supplements can interact with prescribed analgesics
56
Q

reducing pain perception and reception

A

Remove or prevent painful stimuli

57
Q

Control painful stimuli in patient’s environment by:

A
  • Tightening and smoothing wrinkled bed linen
  • Repositioning to relieve pressure points
  • Adjusting to avoid laying on the tubing
  • Changing wet or soiled dressings
  • Lifting patient (not pulling)
  • Avoiding skin exposure to irritants
  • Prevent constipation with fluids, diet, and ambulation
58
Q

Keys to success of pain management is

A

-An ongoing pain assessment
-An ongoing evaluation of the efficacy of interventions: (Does the patient feel relief?
Any side effects from the given medications? What is the therapy that works best for the patient? )

59
Q

Pharmacological pain therapies

A

The “ideal” analgesic that is highly effective without significant side effects does not exist yet.

60
Q

Analgesics

A

The most common and effective pain management method

61
Q

Three types of analgesics

A
  1. non-opioids
  2. opioids (narcotics)
  3. adjuvants (co-analgesics)
62
Q

Non-opioids

A
  1. Acetaminophen

2. Non-steroidal anti-inflammatory drugs

63
Q

Acetaminophen major side effect

A

hepatotoxicity

64
Q

Non-steroidal anti-inflammatory drugs major side effect

A

gastrointestinal bleed and renal insufficiency

65
Q

opioids (narcotics)

A

morphine, hydromorphone, fentanyl, oxycodone

66
Q

Major side effects of opioids

A

constipation, central nervous system changes, respiratory and cardiac depression

67
Q

Adjuvants (co-analgesics)

A

Variety of medications that enhance analgesics

68
Q

Multimodal analgesia

A
  • Combines drugs with at least two different mechanism of action so the pain control can be more efficient
  • Medications target different sites in the peripheral and central pain pathways
  • The allow for lower-than usual doses of multiple medications (Lower risk for side effects)
69
Q

Patient-Controlled Analgesia (PCA)

A
  • Helps to achieve better pain control by self-administration of opioids
  • Maintains constant blood level of opioids
  • Minimal risk of overdose
70
Q

How is Patient-Controlled Analgesia (PCA) delivered?

A

by pushing a button and deliver a specific dose of opioid, which is pre-programmed

  • Patient teaching is critical to the safe and effective use
  • Family members cannot push the button for the patient
71
Q

Topical Analgesics

A

Over the counter creams, ointments, and patches applied to the painful area

72
Q

local anesthesia

A

Infiltration of anesthetic medication to induce loss of sensation to body part by inhibiting nerve conduction

73
Q

Perineural local anesthetic infusion

A
  • Surgeon places the tip of unsutured catheter near nerves and the catheter exits from surgical wound
  • Usually placed for 48 hours
  • Sometimes left in after discharge
    ex) on-Q pump
74
Q

Epidural analgesia

A
  • Opioids as single agents or in combination with local anesthetic is administered into epidural space
  • Treats acute pain
  • Less adverse effects compared to general anesthesia
75
Q

Epidural Analgesia is inserted with

A

Inserted with a needle into particular vertebrae requiring analgesia

76
Q

Nursing implications for local and regional anesthesia

A
  • Provide emotional support during anesthesia insertion
  • Motor and autonomic function (bowel and bladder control) may be temporarily lost
  • Reassure pt that numbness, tingling, and coldness are common
  • Protect pt from injury until full sensory and motor functions return
  • Assess for symptoms of infection at the insertion site
77
Q

Cancer Pain

A
  • Can be chronic or acute

- Choose interventions based on pt’s condition and characteristics of pain change

78
Q

Breakthrough pain

A

Transient worsening of the pain:
Incident pain
End-of-dose failure pain
Spontaneous pain

79
Q

Barriers to effective pain management

A
  • physical dependence
  • addiction
  • drug tolerance
80
Q

Physical dependence

A

withdrawal symptoms after abrupt cessation of opioid drug

81
Q

Addiction

A
  • Disease with genetic, psychosocial, and environmental factors
  • Impaired control over drug use, compulsive use, and continued use despite the harm
82
Q

Drug Tolerance

A

Getting used to the drug; no longer benefiting from the drug’s one or more effects

83
Q

Evaluation

A
  • Reassess signs and symptoms of pt’s pain response including the severity, character, and pt’s self report
  • Evaluate the family’s observation of patient’s response to therapies if applicable
  • Evaluate impact of pain on physical and social functioning
84
Q

Evaluating impact of pain on physical and social functioning

A
  • If the intervention is successful, encourage the pt in self-care activities
  • If the intervention is not successful, stop immediately and look for alternatives (Time and patience are necessary to evaluate the maximum effect)

NURS 305 (30 decks)

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